On the cusp - it could go either way!

First time posting, but I've been reading posts for weeks now.  This is such a great resource for WLS exploration and education!

My insurance requires 40 BMI, or 35 to 39 with comorbidities, and a 5 yr weight history (among other things, but those 2 are my areas of concern).  I have NO comorbidities; my BMI is 39.9 currently with the lowest in the previous 5 years being 34.7.  My insurance is BCBS of TN.

My doctor's office is submitting my paperwork tomorrow to insurance for approval.  I'm so close to their requirements it could go either way.  Sadly, I can't self pay and desperately need the surgery.

Any words of wisdom? Should I ask my doctor not to submit until I weigh again, making it easily 40 BMI?  I could have mild sleep apnea - only minor symptoms - should I have the test done before submission just in case, or do that if I am denied?

Your input is greatly appreciated!

Wear ankle weights!, put rocks in your pockets etc the next time you get weighed, that should put you over the hump! LOL! or eat high salt foods to make you retain water. Good luck, hope you get approved.

I am sure you were just making a joke, but honestly, ankle weights or rocks in your pockets to add weight is actually considered insurance fraud and could put your policy in jeopardy. 

UMMMM, that is insurance fraud.

I would wait until you weigh again and have a BMI of 40.0. Most insurance companies are very strict. Appealing a denial can be very time consuming so if it's a matter of waiting to weigh again, I would just wait. You could drink a couple bottles of water before your next visit and that could do it. 

Rather than risk being denied because you don't meet the published requirements, which is a very different situation than being denied when you DO meet the requirements but just didn't submit some piece of missing documentation, I would hold off until your BMI is over 40 or I would go ahead and have the sleep test and see how it comes out so that you have the necessary comorbid condition.  If you do the latter, though, and you don't gain any weight during the delay, be VERY sure that your policy doesn't require two conditions if your BMI is under 40 (because many do).

I wouldn't risk being denied because you don't meet the requirements when you're so close to being eligible!

Lora

If your insurance requires a five year weight history, then even if you gain a little weight to make your BMI 40, you wouldn't meet their requirements, right?  Because your lowest weight in the last five years is under a BMI of 35.

I'd get tested for sleep apnea, if I was you.  but even if you have it, if your BMI was under 35 in the past five years, would they approve it?

Great questions, and I'm not really sure.  If my insurance company happens to round up, I'll meet criteria.  I'm hopeful my doctor's office wouldn't submit it if there are huge issues, but I'm going to reach out to and ask more questions just to be sure.  Thanks everyone for the input!  I really appreciate it.

I was underfat/overtall and wound up in 6 months of appeals that had to go all the way to the medical director of my husband's company. I was at 38.8 and my insurance required 40. Doc's office said, oh, don't worry, they'll accept 38.8. Guess what. No they didn't.

My advice: get your doc to HOLD OFF on the submission and request a reweigh/remeasure on your height. Go late in the day, eat a big lunch, leave keys/change in your pockets, wear lots of layers and lug-soled boots, don't stand up too tall when they check your height, but DO WHAT YOU NEED TO DO to trigger that 40 BMI. THEN submit. Even if it takes you an extra week, it will save you months in appeals stress, worry, frustration, and expense (I had to pay for an advocate to run my case for me).

Requirements are requirements and they exist for a reason.

Trust me on this.

Laurie

OMG - so close.  I wouldn't suggest ankle weights, but lots of salt could retain you some water to add to the weight.